Randomized controlled trials have compared the early and mid-term prognosis of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, the results are controversial, and there is limited information on graft patency and long-term outcomes.
Betweeen May 2007 and October 2011, 349 patients were randomized to off-pump or on-pump CABG as part of the CORONARY trial at Fuwai Hospital. The primary outcome was coronary bypass graft patency, which was assessed at a mean of 6.7±1.7 years after surgery by multidetector computed tomography. A secondary endpoint was a composite outcome of death, nonfatal myocardial infarction, repeat coronary revascularization, or stroke; mean follow-up was 6.5±1.7 years. Graft patency was compared between the off-pump and on-pump CABG treatment arms in the 206 patients with follow-up computed tomography.
There were 107 patients in the off-pump CABG group and 99 in the on-pump group during the follow-up period. These patients underwent a total of 723 grafts, and the overall rate of graft patency did not differ significantly between the off-pump and on-pump groups (87.4% vs 88.9%, P=0.527). The patency rate of the posterior descending branch was lower than average. Higher incidence of mortality, nonfatal myocardial infarction and repeat revascularization was found in the off-pump patients however it did not reach significance.
There were no statistical differences in graft patency rates in off-pump versus on-pump CABG patients during the long-term follow-up. On-pump CABG group appeared to offer a better long-term prognosis even with no statistical differences for the limited study population.

Copyright © 2020. Published by Elsevier Inc.

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